Calculi allgemein Anhang 2


[Dr. Lizme Ajith]

Renal calculi or renal stones consist of aggregates of crystals and small amounts of proteins and glycoproteins. Different types of stones occur in different parts of the world. Studies have shown that 4% of the total population has stones in the urinary tract.


The exact aetiology is unknown, the various predisposing factors may be

1) Dietary factors:

Diet rich in red meat, fish, eggs.

Diet rich in calcium: milk, spinach, rhubarb etc produce calcium oxalate stones.

Diet lacking in vitamin A causes desquamation of renal epithelium and the cells form a nidus around which the stone is deposited.

2) Renal infection: Organisms such as streptococci, staphylococci, proteus, pseudomonas, klebsiella, E.coli produce recurrent urinary tract infection, producing urea which causes stasis of urine precipitates

            calcium formation.

3) Metabolic causes:

a) Hyperparathyroidism: increases the calcium levels resulting in hypercalcaemia and hypercalciuria producing calcium stones.

b) Gout: increases the uric acid levels and cause multiple uric acid stones.

4) Prolonged immobilisation: from any cause, eg: paraplegia is liable to result in skeletal decalcification with increase in urinary calcium favouring the formation of calcium phosphate calculi.

5) Inadequate urinary drainage: as in cases of horse shoe kidney, undescended kidneys are more vulnerable for development of stones due to stasis.

6) Altered urinary solutions and colloids: Dehydration leads to an increased concentration of urinary solutes and tends to cause them to precipitate.

7) Decreased urinary citrate: The presence of citrate in urine as citric acid, tends to keep otherwise relatively insoluble calcium phosphate in solution. When citrate level decreases, it precipitates the urinary


8) Hot climates: cause increase in concentration of solutes by excessive sweating resulting in precipitation of calcium.

9) Randall’s plaque: Randall suggested that initially a small erosion or an ulcer develops on the tip of renal papilla on which minute concretions or minor calcium particles or microlith get deposited and give

            rise to stone formation.


Types of renal calculus:

1. Oxalate calculus (= Cacium oxalate)

The commonest type of stone, called as mulberry calculi. Irregular in shape, covered with sharp projections which tends to cause bleeding. Produces haematuria very early, resulting in deposition of blood over the stone giving a dark colour to it. Hard and single, occurs in infected urine. Can be visualized radiologically.

2. Phosphate calculi (= usually Calcium phosphate/rarely as Magnesium ammonium phosphate = Struvite)

Smooth, round, dirty white to yellow in colour. Commonly occurs in renal pelvis/tend to grow in alkaline urine (proteus organisms present). As it enlarges in the pelvis, it grows and

fills the calyces and slowly forms a stag horn calculus. Produces recurrent urinary infections and bleeding. As they are large, they are usually easy to see on radiographs.

3. Uric acid calculus

Multiple, small, hexagonal, multifaceted. Colour varies from yellow to reddish brown. Occur in acidic urine. Pure urate stones not visible radiologically unless contaminated with calcium salts.

4. Cysteine calculus

In the urinary tract with a congenital error of metabolism that leads to cystinuria or due to decreased resorption of cystine from renal tubules. They are hexagonal, multiple, pink or yellow. Occur in acidic urine. Seen in young girls at puberty. Not visible radiologically due to sulphur content.

5. Xanthine calculus

Extremely rare. They are smooth and round, brick red in colour and show lamellation on cross section.


In all cases the basic initiating factor is super saturation of urine which leads to crystallization. The crystals get deposited on a nidus and when the conditions are favourable, the stone grows.

50% of patients present between the ages of 30 - 50 years. The male to female ratio is 4: 3.


The leading symptoms in 75% of people.

1) Renal pain: posteriorly in the renal angle or anteriorly in the hypochondrium in costal margin or in both. It may be worse on movement, particularly on climbing stairs. It is described as fixed renal pain or

            costovertebral pain.

2) Ureteric colic: When the stone is impacted in the pelviureteric junction or anywhere in the ureter, it results in severe colicky pain radiating from the loin to the groin. It may also extend to the testicles,

            vulva and medial side of thigh. This may be associated with strangury, the painful passage of a few drops of urine, with pallor, sweating and vomiting/groans in agony.

3) Haematuria: common with oxalate stones. The quantity of blood lost is small, but is fresh.

4) Urinary tract infection: fever with chills and rigors, pyuria, burning micturition and increased frequency of micturition may occur. In severe cases, even septicaemia can quickly develop.

5) Rigidity and guarding: abdominal examination during an attack reveals rigidity of the lateral abdominal muscles and of the rectus abdominis. Percussion over the kidney produces a stab of pain and there    may be tenderness on gentle deep palpation.



1. Calculous hydronephrosis: occurs due to back pressure producing renal enlargement. Due to the stretching of the renal capsule, it results in pain in the loin and an associated palpable kidney mass

            suggests hydronephrosis.

2. Calculous pyonephrosis: Kidney is converted into a bag of pus when hydronephrosis becomes infected.

3. Renal failure: Bilateral staghorn calculi may be asymptomatic until they present with uraemia.



1) Radiography: plain x-ray (KUB) helps to diagnose 90% of renal stones. It can be visualized as an opacity which overlies the urinary tract and keeps a relatively constant position during respiration. Enlarged renal shadow can also be made out.

2) Intravenous pyelography or excretora urography: This helps to locate the stone exactly in relation to kidney and ureter and to assess renal function. A radiolucent stone can be seen as a filling defect. Hydronephrosis can also be made out.

3) Ultrasonography: is the most valuable to diagnose the stone, its size and exact location. It also confirms the enlarged kidney.

4) Urine culture and sensitivity: Examination of urine for protein, R.B.C, W.B.C, micro organisms reveals abnormalities of urinary tract, infection etc.

5) Investigation of renal function: Blood examination for urea, creatinine, creatinine clearance etc to rule out renal failure.

6) Investigation to determine underlying causes: plasma calcium, phosphate, parathormone, plasma urate, 24 hour urine urate, cystine and oxalate and calcium.

7) Stone analysis: analysis of any stone that has been passed.



Dietary advice: drink plenty to keep their urine dilute. Fluid intake should be therefore 3 litres per day, more if the climate or patient’s occupation causes much sweating.

In hypercalciuria: intake of milk, cheese and other dairy products should be avoided.

In oxalate stones: avoid spinach, rhubarb, strawberries, plums and asparagus.

In hyperuricaemia: avoid redmeats, inards and fish rich in purines.

In cystinuria:.Eggs, meat and fish are high in sulphur containing proteins and should be restricted


Non operative treatment:

- Small stones less than 5 mm in size pass off with intake of copious amount of fluids and at times forced diuresis. Intravenous hydration may help pass the stones spontaneously.

- extracorporeal shock wave lithotripsy: the calculus is bombarded with shock waves of sufficient energy so that it will disintegrate into fragments using lithotriptors. The fragments then pass down the ureter and are cleared out.

Operative treatment:


Homeopathic treatment:

Berb.: treatment: Renal colic < l. Stitching, cutting pain from l. kidney following course of ureter into bladder and urethra. Burning and soreness in region of kidneys. Pain in small of back, SENsitive to touch in renal region < sitting/lying/from jar/fatigue/motion/any sudden jarring movement/walking/riding in carriage.

Numbness, stiffness and lameness with painful pressure in renal and lumbar regions. Bubbling sensation in kidneys. Urine greenish, blood red, with thick, slimy mucus, transparent, reddish or jelly like sediment. Rheumatic and gouty complaints with urinary diseases.

Canth.: Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during and after urination. Violent paroxysms of cutting and burning in whole renal region. Violent tenesmus and strangury. Urine scalds and passed drop by drop. Membranous scales looking like bran in water. Urine jelly like, shredy. Pain raw, sore, burning in every part, internally and externally. Over sensitiveness of all parts. Drinking even small quantities of water increases pain in bladder.

Lyc.: Renal colic, r. Pain shooting across lower abdomen from r. to l. Pain in back relieved by urinating. Urine slow in coming, must strain. Retension. Polyuria during night. Red sand in urine. Uric acid diathesis. Child cries before urinating. Pains drawing, aching < 16 – 20 h. Upper part of the body emaciated, lower part semidropsical. Ailments from fright, anger, mortification, reserved displeasure. Avaricious, greedy, miserly, malicious, pussilanimous. Excessive accumulation of flatulence, lower abdomen. > warm food and drinks.

Sars.: Passage of small calculi or gravel, renal colic, stone in the bladder. Excruciating pains from right kidney downwards. Severe almost unbearable pain at conclusion of urination. Urine bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Painful distension and tenderness in bladder, urine dribbles while sitting, passes freely when standing. Air passes from urethra, child screams before and while passing urine.

Tab.: Renal colic, violent spasmodic pains along ureter, left side. With deathly nausea and vomiting. Vomiting violent, with cold sweat, on least motion, with faintness > open air. Nausea incessant as if seasick > in fresh cold air. Vertigo, death like pallor, on opening the eyes. Face pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of stomach. Icy coldness of surfaces.

Nux-v.: Renal colic, r. Pain ext. r. thigh and to the genitals. Frequent ineffectual urge for urination with dribbling of urine. Haematuria, strangury. While urinating, itching in urethra and pain in neck of bladder. Backache, must sit up or turn over in bed. Adapted to thin, irritable, zealous, nervous, literary, studious, responsible persons. Bad effects of coffee, tobacco, alcohol, highly spiced food, overeating, long continued mental exertion. Over sensitiveness to all external impressions. Frequent ineffectual urging for stool.

Oci-s.: Renal colic, r. Uric acid diathesis. Red sand in urine. High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody, brick dust red or yellow sediment. Odour of musk. Pain in ureters, cramps in kidneys.

Bell.: Violent spasmodic pains in kidney region (r.). Pain comes suddenly, last indefinitely and cease suddenly. Pains usually in short attacks. Redness of eyes and face, throbbing of brain and carotids. Abdomen tender, distended, < least jar (of the bed)/slight noise/light/lying down. > pressure/tight bandaging/wrapping up. Bilious lymphatic plethoric constitutions.

Cham.: Insupportable pains in loins and hips. Pains seem unendurable, drives to despair < heat/evening before midnight/with heat/thirst and fainting with numbness of affected parts/eructations. Violent pains, drive him out of bed, compels to walk about. Over sensitive to pain, to open air. Cannot endure anyone near him, is cross/irritable/easily angered.

Coloc.: Pain urinating over whole abdomen. Vesical catarrh, discharge like fresh white of egg. Red hard crystals. Renal colic < l. Agonising pain in abdomen causing patient to bend double, with restlessness, twisting and turning to obtain relief. > hard pressure. Pains < eating and drinking > warm application. Shooting pains like electric shocks. Complaints from anger, indignation, mortification.

Dios.: Renal colic with pains radiating to the extremities. Colic pains < bending forward/lying. > standing erect/bending backwards. Violent twisting colic, occurring in regular paroxysms „As if abdomen grasped and twisted by a powerful hand“. Pain suddenly shift to different parts, appear in remote localities as fingers and toes.

Hydrangea.: Renal calculi, gravel, profuse deposit of white amorphous salts in urine. Renal colic, sharp pain in loins, especially left. Burning in urethra and frequent desire. Urine hard to start. Bloody urine, heavy deposit of mucus. Great thirst with abdominal symptoms and enlarged prostate.

Pareir.: Renal colic, pain going down the thighs. Neuralgic pain in the anterior crural region. Constant urging, great straining. Can emit urine only when he goes on his knees, pressing head firmly against floor. Black, bloody, thick mucus urine. Dribbling after micturition. Urethritis, prostatitis.

Fab.: Excoriating urine and calculi. Uric acid diathesis. A terebinthine diuretic. Vesical tenesmus and burning after urination. Dysuria, cystitis, prostatitis, gonorrhea. Cholelithiasis and liver affections.

Hedeoma.: Dull burning pain over left kidney. Pain along left ureter. Dragging pain from kidney to bladder. Red sand in urine. Frequent urging, cutting pains. Frequent intense desire to urinate and inability to retain urine for more than few minutes, > urinating.

Epig.: Renal calculi, gravel, uric acid deposits. Fine sand in urine of a brown colour. Dysuria, tenesmus after urination. Burning in neck of bladder while urinating. Chronic cystitis, mucopus, pyelitis, incontinence of urine.

Eryng-a.: Renal colic. Pain behind pubes. Congestion of kidneys with dull pain in back, running down the ureters and limbs. Difficult and frequent micturition. Strangury with nervous erethism. Tenesmus of bladder and urethra. Thick yellow mucus discharges.

Eupat-pur.: Deep dull pain in kidneys. Dysuria, haematuria, strangury. Boring in bladder and urethra on urinating. Vesical irritability in women. Insufficient flow, milky. Albuminuria, dropsy, diabetes, enlarged prostate.

Thlas.: Renal colic. Accumulation of gravel. Brick dust sediment. Urine heavy, phosphatic. Dysuria and spasmodic retension. Uric acid diathesis. Renal and vesical irritation. Urethritis, urine runs away in little jets. Haematuria and albuminuria.

Oxyd.: Vesical calculi. Irritation at neck of bladder. Urine suppressed. Dropsy. Deranged portal circulation. Prostatic enlargement.

Solid.: Urine scanty, reddish brown, thick sediment, dysuria, gravel. Pain in kidneys extends forward to abdomen and bladder. Urine difficult and scanty, albumen, blood and slime. Kidneys sensitive to pressure. Backache of congested kidneys.

Pariet.: Renal calculi. Night mares, patient dreams of being buried alive.

Stig.: Renal lithiasis, nephritic colic. Blood and red sand in urine. Suppression and retension of urine. Dysuria, tenesmus after urinating. Uric and phosphatic gonorrhea. Urinary symptoms associated with organic heart disease.

Ipom.: Renal colic, aching in small of back and extremities. Pain in left lumbar muscles on stooping. Aching in top of right shoulder.

Vesi.: Smarting, burning sensation along urethra and bladder with frequent desire to void urine often with strangury. Cystitis, irritable bladder.

Xant.: Severe pain in kidneys, cystitis and gravel. Pain from ureter to bladder and testicles. Pain in small of back returns from least chill or damp.

Uva.: Calculous inflammation. Chronic vesical irritation with pain, tenesmus and catarrhal discharges. Burning after the discharge of slimy urine. Frequent urging with severe spasms of the bladder. Urine contains blood, pus and much tenacious mucus, with clots in large masses. Painful dysuria. Involuntary green urine. Cystitis with bloody urine.

Coc-c.: Urinary calculi, urates and uric acid. Brick red sediment. Haematuria. Deep coloured thick urine. Dysuria, urging to urinate. Lancinating pains from kidneys to bladder. Chronic bronchitis complicated with gravel.

Chinin-s.: Small amount of urea and phosphoric acid with excess of uric acid and abundance of chlorides. Bloody urine. Albuminuria. Chronic interstitial nephritis. Turbid, slimy, clay coloured, greasy sediment. Complaints from suppressed malaria.

Benz-ac.: Excess of uric acid in urine. Urine high coloured, urinous odour highly intensified. Dark brown, highly offensive. Gonorrheal and syphilitic patients. Pain suddenly change their locality. Rheuma and gout.

Nit-ac.: Cloudy phosphatic urine. Scanty, dark, offensive, smells like horse’s urine. Urine bloody, albuminous, turbid, looks like remains of cider barrel, cold on passing. Pricking splinter like pains. Complaints after continued loss of sleep, over exertion of mind and body.

Med.: Renal colic. Painful tenesmus when urinating. Severe pain in renal region > by profuse urination. Intense pain in ureters, with sensation of passing of calculus. Urine flows very slowly. Ailments from suppressed gonorrhea. Women with chronic pelvic disorders. < thinking of ailments/day time. > lying prone.

Sep.: Red adhesive sand in urine. Chronic cystitis, slow micturition with bearing down sensation above pubes. > by violent exercise, warm application. Involuntary urination during first sleep. Urine highly offensive, must be removed from the room. Pains from other parts to back, attended with shuddering. Sensation of ball in inner parts. Weeps easily, indifference to those loved best.

Chima.: Urine loaded with ropy, mucopurulent sediment. Urine turbid, offensive, scanty. Burning and scalding. Must strain before flow comes. Unable to urinate without standing with feet wide apart and body inclined forward. Prostatic enlargements.

Senec-a.: Renal colic, great heat and constant urging. Nephritis. Scanty, high coloured, bloody with much mucus and tenesmus. Irritable bladder with headache. Backache of congested kidneys. Functional amenorrhea.

Cal-ren.: Gravel and renal calculi.

Piperazinum.: Urinary calculi, uric acid diathesis. Constant backache. Urine scanty. Rheumatic urethritis.

Polyg-s.: Pains of nephritic colic, lancinating pain along spine. Suppurative nephritis. Aching pain in hips and loins.

Nit-m-ac.: Gravel. Oxaluria, almost a specific. Urine cloudy, burning in urethra. < eating meat, alcohol.

Baros.: Gravel. Irritable bladder with vesical catarrh. Mucopurulent discharges.



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